Transcript CDC Guidelines for Dental Healthcare Settings

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2003 CDC Guidelines for Dental
Healthcare Settings
Infection Control, DA116
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Review:
• OSHA = LAW
• CDC = RECOMMENDATIONS
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OSHA Bloodborne Pathogens 1991
CDC Guidelines 1993
OSHA Needlestick Safety and Prevention Act 2001
CDC Guidelines for Infection Control in Dental HealthCare Settings — 2003.
• Built on previous laws and recommendations
OSHA Needlestick Safety and Prevention Act 2001
• Employers must consider using safer needle devices to
prevent needle-stick injuries
• Employees must be involved in identifying and
choosing the new devices for office use
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CDC 2003 Changes
• 2003 CDC guidelines follow previous CDC guidelines
and OSHA Standards but add some details or slight
changes to the original documents.
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Standard Precautions
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Apply to all patients
Integrate and expand Universal Precautions
to include organisms spread by blood and
also
– Body fluids, secretions, and excretions except sweat,
whether or not they contain blood OPIM
– Non-intact (broken) skin
– Mucous membranes
Elements of Standard Precautions
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Handwashing
Use of gloves, masks, eye protection,
and gowns
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Injury prevention
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Patient care equipment
Environmental surfaces
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Personnel Health Elements
• Vaccinations
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HBV
Influenza
Measles, Mumps, Rubella
Varicella
– Documentation of vaccination
or immunity
– Baseline TB test upon
employment
• Post-exposure prophylaxis
(PEP) to
• HBV, HCV, HIV
• Offices should make advance
arrangements for testing and
treatment with local
occupational health physician so
no delays in PEP occur
• Continued Bloodborne
Pathogens Standard
compliance
• Written work restriction
policies for workers infected
with or exposed to major
infectious diseases
• Annual evaluation of safety
devices such as dental safety
syringes
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Guidance for selecting and using PPE
• Protective eyewear
– Solid side shields
• Thick utility gloves
– Instrument cleaning and
housekeeping
• Sterile surgeons’ gloves
for oral surgery
• Respirator protection
– Patients with TB
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Hand Care
• When/How to use:
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Plain soap
Antimicrobial soaps
Alcohol-based hand-rubs
Oral surgical antisepsis
• Antimicrobial soaps or
alcohol rubs with
persistent activity
• NOTE: WASH hands for every 510 hand-rubs to keep hands clean
– Lotion:
• Prevent/ease skin dryness
• Caution: type of lotion
– Irritant and contact
dermatitis
– Latex (type I)
hypersensitivity
• Establish latex-safe
environment if necessary
– Short fingernails
• no artificial nails
• no finger jewelry
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Sterilization and Disinfection
• More detailed than 1993 guidelines
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Sterilizer monitoring
Sterilization of unwrapped items
Storage of sterilized items
Differences between types of disinfecting chemicals
Water quality
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Special considerations
• CDC 2003 gives specific guidelines for several
situations common to the dental office
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Dental Handpieces and Other Devices
Attached to air and waterlines
but removable
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Clean and heat sterilize
intraoral devices that can be
removed from air and
waterlines
Follow manufacturer’s
instructions for cleaning,
lubrication, and sterilization
Do not use liquid
germicides or ethylene
oxide
Permanently attached to air
and waterlines
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Items do not enter patient’s
mouth but may become
contaminated
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Use barriers and change
between uses
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Clean and intermediate-level
disinfect the surface of
devices if visibly
contaminated
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Saliva Ejectors
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Previously suctioned
fluids might be retracted
into the patient’s mouth
when a seal is created
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Do not advise patients to
close their lips tightly
around the tip of the saliva
ejector
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Dental Radiology
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Wear gloves and other appropriate PPE as necessary
Use barriers or single-use items when possible
Heat sterilize heat-tolerant radiographic accessories
Transport and handle exposed radiographs so that they
will not become contaminated
Avoid contamination of processing equipment or
computer equipment if using digital
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Precautions for Parenteral Medications
(medications injected into body)
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IV tubings, bags, connections,
needles, and syringes are
single-use, disposable
Single dose vials
– Do not administer to multiple
patients even if the needle on the
syringe is changed
– Do not combine leftover
contents for later use
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Single-Use (Disposable) Devices
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Intended for use on one patient during a
single procedure
Usually not heat-tolerant
Cannot be reliably cleaned
Examples: Syringe needles, prophylaxis
cups, and plastic orthodontic brackets
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Pre-procedural Mouth Rinses
– Have a patient use an anti-microbial mouth rinse prior to
dental procedure
• Reduces microorganisms in the
mouth, aerosol and spatter
– Scientific evidence is inconclusive
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Precautions for Surgical
Procedures
Surgical
Scrub
Sterile Irrigating
Solutions
Sterile Surgeon’s
Gloves
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Handling Biopsy Specimens
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Place biopsy in sturdy,
leakproof container
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Avoid contaminating the
outside of the container
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Label with a biohazard
symbol
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Extracted Teeth
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Considered regulated
medical waste
– Do not incinerate
extracted teeth
containing amalgam
– Clean and disinfect
before sending to lab for
shade comparison
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Can be given back
to patient
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Educational setting:
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Remove visible blood
and debris
Maintain hydration
Autoclave (teeth with no
amalgam)
Use Standard
Precautions
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Laser/Electrosurgery Plumes
and Surgical Smoke
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Destruction of tissue creates smoke that may
contain harmful by-products
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Infectious materials (HSV, HPV) may contact mucous
membranes of nose
No evidence of HIV/HBV transmission
Need further studies
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– Note: most offices use HVE to contain fumes due to
offensive odor
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Dental Laboratory
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Dental prostheses,
appliances, and items used
in their making are potential
sources of contamination
Handle in a manner that
protects patients and DHCP
from exposure to
microorganisms
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Clean and disinfect
prostheses and impressions
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Wear appropriate PPE until
disinfection has been
completed
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Clean and heat sterilize
heat-tolerant items used in
the mouth
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Communicate specific
information about
disinfection procedures
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Infectious Diseases
• Bloodborn Pathogens are still a concern but CDC 2003
also refers to TB and prion diseases
Transmission of Mycobacterium tuberculosis
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Spread by droplet nuclei
Healthy immune system usually prevents spread
Bacteria can remain alive in the lungs for many years (latent TB
infection)
• Risk is low in dental setting
• Baseline TB test recommended at initial hire
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Preventing Transmission of TB in
Dental Settings
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Assess patients for history of TB
Defer elective dental treatment
If patient must be treated:
– DHCP should wear respirator mask
– Separate patient from others/mask/tissue
– Refer to facility with proper TB infection
control precautions
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Creutzfeldt-Jakob Disease (CJD) and other
prion diseases
• Prion: altered form of a
normal cellular protein
– Animal and human
forms
• Long incubation period;
very rare
– Results in a fatal,
degenerative CNS
disorder
• “mad cow”
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Infection Control for Known
CJD or vCJD Dental Patients
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Use single-use disposable items
and equipment
Consider items difficult to clean
(e.g., endodontic files,
broaches) as single-use
disposable
Keep instruments moist until
cleaned
Clean and autoclave at 134°C
for 18 minutes
Do not use flash sterilization
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Program Evaluation
• Periodic observational assessments
• Checklists to document procedures
• Routine review of occupational exposures to bloodborne
pathogens